David Koppel

Preliminary assessment of skeletal stability after sagittal split mandibular advancement using a bioresorbable fixation system

We studied skeletal stability during the first year after mandibular advancement and fixation with bioresorbable self-reinforced poly-L-lactide (SR-PLLA) screws in 11 patients by cephalometric measurements. We compared these with a cohort of 11 patients, in whom titanium screws were used for fixation. We found no significant difference between the two groups in the median preoperative cephalometric values and the median changes after operation. There was also no significant difference between the two groups regarding the median extent of relapse 1-year after operation. We conclude that bioresorbable SR-PLLA screws are comparable to metallic screws for fixation of bone after sagittal split mandibular advancement.

Telemetric Intracranial Pressure Monitoring in Syndromic Craniosynostosis.

Syndromic and nonsyndromic craniosynostosis can be associated with raised intracranial pressure (ICP). After corrective surgery, raised ICP persists or reoccurs in a subgroup of patients. The standard procedure for monitoring ICP is insertion of a percutaneous intraparenchymal probe for a limited time, usually 24 to 48 hours. However, in selected patients repeated ICP measurements might be useful in the clinical setting, and a noninvasive method for achieving this would be desirable. The authors present the use of a telemetric ICP monitoring system implanted during cranial vault expansion in a child with syndromic craniosynostosis. This system, once implanted, allows for noninvasive transdermal ICP readings and might represent a promising alternative to conventional ICP monitoring devices in selected patients with craniofacial conditions.

The Sepsis Syndrome in Odontogenic Infection

Odontogenic infection is a common cause of sepsis in the head and neck. Infection frequently spreads in a predictable pattern within the fascial spaces of the neck and can result in airway compromise. Often the condition results in significant morbidity and a prolonged hospital stay. In this study, we assessed the incidence of sepsis syndrome in patients presenting to a regional maxillofacial unit with odontogenic infection. Six months of prospective data were collected, with sixty-seven patients included. The focus of infection was mandibular in 70.1% and maxillary in 29.9%. The mean length of stay was four days and 61.2% of patients were diagnosed with sepsis syndrome on admission. This group remained in hospital significantly longer than non-sepsis syndrome patients (sepsis=4.7 days, non-sepsis=2.9 days. p=0.0145.) The site of infection was not a significant factor in the development of the systemic inflammatory response syndrome (SIRS).

Spontaneous lingual haematoma secondary to thrombolysis

A 71 year old man developed difficulty speaking and swallowing approximately three hours after he was treated with intravenous alteplase (10 mg bolus followed …

Massive Orbital Recurrence of Uveal Melanoma without Metastases after 28 Years

A 64-year-old Caucasian male presented with non-axial proptosis of the left eye which had progressed over 4 months with recent discomfort and diplopia. He was otherwise well. His past ocular history was of collar-stud choroidal melanoma in the left eye aged 36. This tumour was in the inferonasal quadrant with a diameter of 10 mm. Trans-scleral resection was performed with laser photocoagulation around the tumour base preoperatively to reduce the risk of retinal detachment. Histological examination of the tumour showed a pigmented uveal melanoma of …

Morphometric Analysis of the Posterior Cranial Fossa in Syndromic and Nonsyndromic Craniosynostosis

Abstract Posterior cranial fossa (PCF) anatomy can be abnormal in craniosynostosis, and hindbrain herniation may occur. This study analyzed PCF anatomy in single suture and complex craniosynostosis. Children with craniosynostosis and age-matched controls were identified. Cephalic index (CI) for cranial vault and PCF as well as tentorial (TA) and occipital angles (OA) were measured on preoperative imaging. Children with syndromic (N = 6), bicoronal (N = 4), sagittal (N = 12), and metopic synostosis (N = 4) as well as controls (N = 10) were enrolled. Mean CI for cranial vault was 0.89, 0.93, 0.65, 0.74, and 0.78, respectively. Corresponding CI for PCF was 0.81, 0.93, 0.62, 0.74, and 0.78. Mean TA and OA were 45.4° and 96.6° in syndromic, 39.7° and 87.0° in bicoronal, 34.0 and 75.0° in sagittal, 39.7° and 87.0° in metopic synostosis, and 42.9° and 88.3° in controls. While CI, TA, and OA in metopic synostosis were similar to controls, abnormalities were found in syndromic, bicoronal, and sagittal synostosis. Syndromic and bicoronal craniosynostosis patients had a higher CI for both cranial vault and PFC as well as larger TA and OA, indicating a brachycephalic skull with steep tentorium and narrow PCF. In sagittal synostosis, CI for cranial vault and PCF were lower and TA and OA smaller, reflecting scaphocephalic deformity also at PCF, with a flat tentorium. This study provides basic PCF morphometry in craniofacial conditions.

Cleft lip and palate with associated digital and cardiac anomalies: a new dominant orofacial clefting syndrome?

Introduction Cleft lip with or without cleft palate is a feature of more than 200 recognized syndromes. Dinno (1987) described a three-generation of a family with a combination of cleft lip and palate, prominent eyes and congenital heart disease, but since then there has been a paucity of reports of patients with a similar combination of features. We now describe a father and son with cleft lip and palates, atrial septal defects and unusual thumbs, and propose that this is a distinct autosomal dominant syndrome.

Serious documentary or freak show

Is it right for medical professionals to participate in television programmes that may sensationalise people’s illnesses? David Koppel reports back on his own role in one show